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General NPI Number Information
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NPI Number | 1558146159
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Entity Type | Individual
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Provider Name | JORDAN ARCINIEGA-BUENO
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Gender | Male
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Dates
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Enumeration Date | 08/30/2023
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Last Update Date | 01/25/2024
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Provider Practice Location Address
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Address Line | 2570 48TH ST
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City | SACRAMENTO
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State | CA
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Zip | 95817-1541
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Country | US
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Telephone | 916-600-5458
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Fax |
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Provider Business Mailing Address
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Address Line | 1857 LA PORTE AVE
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City | SAN JOSE
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State | CA
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Zip | 95122-2046
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Country | US
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Telephone | 408-600-5458
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 63708
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License Number State | CA
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